Although rheumatic fever is uncommon in the United States, there are still 470,000 new cases yearly. Hence, you must be familiar with it and how you can adequately take care of your child if they become afflicted. This article aims to provide you with such information.

What is Rheumatic Fever?

Rheumatic fever is a disease caused by a streptococcus infection, and it generally happens following strep throat or scarlet fever. It typically affects children aged 5-15, but adults can acquire it as well. 

Rheumatic fever is prevalent in south-central Asia, sub-Saharan Africa, and some parts of Australia and New Zealand. 

It is an autoimmune disease that can affect your child’s skin, joints, brain, and heart. But it is not contagious. It causes your child’s immune system to attack its tissues, which results in inflammation.  

Symptoms of Rheumatic Fever

Streptococcus bacteria also cause rheumatic fever. However, strep throat does not always cause it. But if your child gets an early diagnosis and treatment for strep throat, they can prevent it from happening.

If your child exhibits any of these symptoms, you should consult your physician.

  • Inflammation of the knees, ankles, elbows, and wrists (arthritis)
  • exhaustion
  • Fever
  • Rosacea shaped like pink rings (this is an uncommon symptom)
  • A fast heartbeat, a fast breathing pattern, chest pain, or shortness of breath – all signs of congestive heart failure
  • Uncontrollable, jerky movements of the body (also known as “chorea”).
  • Painless lumps under the skin near joints ( an uncommon symptom)

In addition, a child with a rheumatic fever can have:

  • an abnormal heartbeat
  • an enlarged heart and
  • fluid around the heart

Who Gets Rheumatic Fever?

Rheumatic fever can affect anyone – however, young children (5-15 years old) are more susceptible. 

The onset of rheumatic fever usually happens two to three weeks after a strep throat infection or scarlet fever goes untreated. 

In general, age groups less than five years and older than 15 are not at risk of acute rheumatic fever.

Wherever large groups of people gather together, infectious illnesses, such as group A strep, tend to spread. Crowded conditions may increase the risk of getting strep throat or scarlet fever, causing rheumatic fever. For example:

  • in schools
  • childcare centers
  • and military training facilities

Causes of Rheumatic Fever

The immune system overreacts to rheumatic fever, causing your child’s body to attack healthy tissues. This overreaction can occur as a result of neglecting treatment for scarlet fever or strep throat. A group A streptococcus infection becomes resistant when you don’t administer antibiotics appropriately.

As your child’s immune system starts fighting back, the effects can cause damage to organs and healthy tissues instead of bacteria.

Diagnosis of Rheumatic Fever

A single test cannot diagnose rheumatic fever. The doctor can instead check the patient’s medical history, look for signs of illness, and use many tests, including:

  • Echocardiography (or echo): a test that creates a picture of the heart’s activity
  • Using a blood test to determine if your child recently had a group A strep infection
  • Taking a throat swab to test for group A strep
  • Electrocardiogram (EKG): an examination of the heart’s health

In addition to these tests, your child’s healthcare provider will also look for certain signs and symptoms that help confirm the diagnosis. These include:

  • Inflammation of the heart (carditis)
  • Inflammation or pain in more than one joint (polyarthritis)
  • Unusual, uncontrollable jerky movements (chorea)
  • Small, painless, hard bumps under the skin (subcutaneous nodules)
  • A red, irregular rash (erythema marginatum)
  • Fever
  • Previous inflammation of the heart
  • Changes seen in the ECG pattern
  • Elevated markers of inflammation in blood tests, like sedimentation rate or C-reactive protein (CRP)

By combining the results from physical exams, medical history, and these various tests, doctors can make a more accurate diagnosis of rheumatic fever.

Complications Associated with Rheumatic Fever

Rheumatic fever can affect your child for months or sometimes years, and its presence can result in several complications. One of the main complications of rheumatic fever is rheumatic heart disease. Other complications include:

  • Heart failure: It happens when the heart can’t pump enough blood around your child’s body.
  • Damage to the heart muscle: Inflammation weakens the heart muscle and decreases the heart’s ability to pump blood
  • Regurgitation of the aorta: occurs when the aortic valve leaks, causing blood to flow in the wrong direction.
  • Aortic stenosis: Narrowing of the blood vessel that sprouts from the heart (aorta).
  • Irregular heartbeat: It occurs in the upper chamber of the heart.

Rheumatic fever can result in permanent heart damage, stroke, and even death if left untreated. Endeavor to consult your doctor if your child develops any of the symptoms mentioned above.

Dental Care Considerations for Children with Rheumatic Fever

If your child has suffered heart damage due to rheumatic fever, special precautions are necessary before any dental work. Dental procedures can sometimes allow bacteria from the mouth to enter the bloodstream, which may then reach the heart and cause a serious infection known as endocarditis—particularly in children whose heart valves or tissues are already weakened. To help prevent this, your child’s doctor may recommend antibiotics before dental visits or procedures. Always discuss your child’s individual needs with their healthcare provider to determine the best plan.

Treatments for Rheumatic Fever

Medicines containing antibiotics

The pediatrician will prescribe antibiotics and possibly a long-term treatment plan for your child. In extraordinary cases, your child may need lifelong antibiotic treatment. Often, even if a throat culture is negative, antibiotics are given to eliminate any lingering strep bacteria. To help prevent rheumatic fever from returning and causing additional damage to the body, your child might need to take monthly doses of antibiotics for an extended period. This ongoing approach reduces the risk of future strep infections and the potential for further complications related to rheumatic fever.

An anti-inflammatory treatment

A pain medication that is also anti-inflammatory, such as aspirin (Bayer) or naproxen (Aleve, Naprosyn), is often used as an anti-inflammatory treatment. 

Despite the risk of Reye’s syndrome associated with aspirin use in some children’s diseases, aspirin’s benefits in treating rheumatic fever may exceed its risks. Additionally, doctors may prescribe corticosteroids for reducing inflammation.

Bed rest

A doctor may also recommend bed rest for your child and restricting their activities until the significant symptoms have passed. Depending upon the severity of the heart condition, bed rest may be necessary for a few weeks to a few months. In many cases, the recommended duration of bed rest can range anywhere from two to twelve weeks, allowing the body time to recover and the heart to heal properly.

How Can Parents Support a Child Living with Rheumatic Fever?

Caring for a child diagnosed with rheumatic fever requires ongoing vigilance and a partnership with your healthcare provider. Since rheumatic fever can return—especially within the first few years after diagnosis—consistent preventive strategies and clear routines are essential.

Here’s how parents can help their child live well with rheumatic fever:

  • Adhere to Medication Schedules: Your child’s doctor will likely prescribe regular antibiotics to reduce the risk of another episode. Make sure your child doesn’t miss a dose, as long-term antibiotic use is key for protection—sometimes even through adolescence.
  • Frequent Medical Check-Ups: Maintain regular visits with your healthcare provider. These appointments are important to monitor for any complications or returning symptoms, and to adjust treatment as your child grows.
  • Watch for Recurrence: Be vigilant for the early signs of strep throat or scarlet fever, like a sore throat, fever, or rash. Early treatment can help prevent rheumatic fever from coming back.
  • Support a Heart-Healthy Lifestyle: Encourage your child to eat nutritious foods, get plenty of rest, and engage in gentle physical activities as recommended by the doctor. Activities may be limited if there is heart involvement, so always check before starting sports or intense exercise.
  • Emphasize Hand Hygiene: Because infections can trigger relapses, remind your child of the importance of frequent handwashing, especially in group settings like school or daycare.

With attentive care at home and regular guidance from your child’s medical team, most children are able to lead active, healthy lives even after a diagnosis of rheumatic fever.

Can Rheumatic Fever Return?

Yes, rheumatic fever can return if your child gets strep throat or scarlet fever again. 

Prevention of Rheumatic Fever

A complete course of antibiotics is the only way to prevent rheumatic fever after a strep throat infection or scarlet fever. Hygiene is also essential in guarding against grade A strep infection and scarlet fever, which causes rheumatic fever. 

Encourage your child to cough or sneeze into their elbow instead of their hands when they are sick, and wash their hands frequently with antibacterial soap.

When Should You Call a Doctor?

Contact your healthcare provider immediately if you suspect your child has strep throat or scarlet fever. An early diagnosis can prevent rheumatic fever.